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General NPI Number Information
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NPI Number | 1598967507
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Entity Type | Individual
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Provider Name | CHUN JACKSON NG D.C., PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 09/11/2019
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Provider Practice Location Address
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Address Line | 18575 GALE AVE SUITE 278
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91748-1340
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Country | US
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Telephone | 888-997-2674
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Fax | 714-798-2366
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Provider Business Mailing Address
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Address Line | PO BOX 3927
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City | FULLERTON
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State | CA
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Zip | 92834-3927
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC 29413
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 21272
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License Number State | CA
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